Nursing Elites

1. Following a diagnosis of acute glomerulonephritis (AGN) in their 6-year-old child, the parent's remark: "We just don't know how he caught the disease!"? The nurse's response is based on an understanding that:

• A. AGN is a streptococcal infection that involves the kidney tubules.
• B. The disease is easily transmissible in schools and camps.
• C. The illness is usually associated with chronic respiratory infections.
• D. It is not "caught"? but is a response to a previous B-hemolytic strep infection.

Correct answer: D

Rationale: The correct answer is that acute glomerulonephritis (AGN) is not 'caught' but is a response to a previous B-hemolytic strep infection. AGN is generally accepted as an immune-complex disease triggered by an antecedent streptococcal infection occurring 4 to 6 weeks prior. It is considered a noninfectious renal disease. Choice A is incorrect because AGN is not a streptococcal infection that involves the kidney tubules but rather a noninfectious renal disease. Choice B is incorrect as AGN is not easily transmissible in schools and camps but is a result of a previous streptococcal infection. Choice C is incorrect as AGN is not usually associated with chronic respiratory infections, but with a previous streptococcal infection.

2. Which of the following is NOT a warning sign that compensatory mechanisms in a patient in shock are failing?

• A. Increasing heart rate above normal for the patient's age.
• B. Absent peripheral pulses
• C. Decreasing level of consciousness
• D. Increasing blood pressure

Correct answer: D

Rationale: In a patient in shock, increasing blood pressure is not a sign that compensatory mechanisms are failing. As shock progresses and compensatory mechanisms fail, systolic blood pressure will decrease, leading to hypotension, which is a late and ominous sign in these patients. Therefore, choices A, B, and C are warning signs of failing compensatory mechanisms in shock: an increasing heart rate above normal, absent peripheral pulses, and decreasing level of consciousness, respectively. An increasing blood pressure is not indicative of compensatory failure in shock; instead, it may be a sign of compensatory mechanisms still trying to maintain perfusion pressure.

3. A 23-year-old woman is admitted to the infusion clinic after a Multiple Sclerosis exacerbation. The physician orders methylprednisolone infusions (Solu-Medrol). The nurse would expect which of the following outcomes after administration of this medication?

• A. A decrease in muscle spasticity and involuntary movements
• B. A slowed progression of Multiple Sclerosis-related plaques
• C. A decrease in the length of the exacerbation
• D. A stabilization of mood and sleep

Correct answer: C

Rationale: Methylprednisolone infusion is the first-line treatment during an acute exacerbation of Multiple Sclerosis. It is used to decrease the length and severity of a relapse by reducing inflammation in the central nervous system. Choice A, 'A decrease in muscle spasticity and involuntary movements,' is incorrect because methylprednisolone primarily targets inflammation and does not directly address muscle spasticity. Choice B, 'A slowed progression of Multiple Sclerosis-related plaques,' is incorrect as methylprednisolone is not used to slow the progression of the disease but rather to manage acute exacerbations. Choice D, 'A stabilization of mood and sleep,' is not an expected outcome of methylprednisolone administration for Multiple Sclerosis exacerbation as it primarily targets the inflammatory process associated with the relapse.

4. Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient admitted with bleeding esophageal varices?

• A. The medication will reduce the risk of aspiration.
• B. The medication will inhibit the development of gastric ulcers.
• C. The medication will prevent irritation of the enlarged veins.
• D. The medication will decrease nausea and improve appetite.

Correct answer: C

Rationale: The correct answer is: 'The medication will prevent irritation of the enlarged veins.' Esophageal varices are dilated submucosal veins. The therapeutic action of H2-receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acidic gastric contents. While ranitidine can decrease the risk of peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, the primary purpose of H2-receptor blockade in this patient is to prevent irritation and bleeding from the varices, not the other listed effects.

5. A client in the ICU has been intubated and placed on a ventilator. The physician orders synchronous intermittent mandatory ventilation (SIMV). Which statement best describes the work of this mode of ventilation?

• A. The ventilator delivers a set rate and tidal volume regardless of whether the client is attempting to breathe
• B. The ventilator coordinates delivered breaths with the client's respiratory efforts
• C. The ventilator provides a supplemental breath for every third breath of the client
• D. The ventilator provides breaths during the expiratory phase of the client's respirations

Correct answer: B

Rationale: Synchronous intermittent mandatory ventilation (SIMV) is a ventilation mode that coordinates delivered breaths with the client's own respiratory efforts. This mode allows the client to initiate breaths, with the ventilator providing preset breaths at a controlled rate and volume. Option A is incorrect because in SIMV, the ventilator syncs with the client's respiratory efforts. Option C is incorrect as it does not accurately depict the way SIMV works. Option D is also incorrect as SIMV does not specifically provide breaths during the expiratory phase of the client's respirations. Therefore, the correct answer is B, where the ventilator coordinates breath delivery with the client's breathing efforts.

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